Will more chemo help invasive lobular carcinoma?

jobu

What would you do? Anyone had this experience? I'm stressed!!!

After chemo and surgery my pathology shows invasive ductal cancer was gone, but invasive lobular was larger than previously thought. Doctors at UCSF are recomending 4 rounds of Adryomicin to be agressive. Doctors at Califonia Cancer Care say the lobular doesn't respond so I should skip it and move on to radiation and tamoxafin.  I am a single mother with a 10 year old daughter. I want what will give me the best prognosis. Has anyone had this experience or have any thoughts on this?

 Here are my specs:

I am a 49 y/o patient (premenopausal at diagnosis) who was diagnosed with a left breast cancer with mixed ductal and lobular features.  Strongly ER positive 90% PR 10% and her-2 neu negative. MRI showed a 1.7 by 1.4 cm mass and nothing else. I had 4 cycles of TC chemo.  Post chemo MRI showed significant regression.  I had a lumpectomy. Pathology showed residual lobular carcinoma speckled across a 5.5 cm region with the largest deposit measuring 1.2 cm. The lobular cancer was grade I and well-differentiated with no lymphatic/vascular invasion.  2 lymph nodes showed no metastatic cancer.

 Thanks much!

 

 

Seabee

A number of studies, including one reported by the National Cancer Institute, indicate that Adriamycin is not significantly effective against HER-2 negative cancer.See http://www.cancer.gov/clinicaltrials/results/HER2-anthracycline0108.

What chemo did you get before that produced significant regression?

I'm not an oncologict, so take my opinion for what it's worth, but I would hesitate to opt for more chemo of a kind that I doubted would be effective. Radiation and hormonal therapy would seem more likely to be beneficial, esp. if you are Grade 1.

jobu

I had 4 rounds of Cytoxin and Taxotere. The invasive ductal disappeared, but the lobular didn't. And it was much larger than expected. Small tumors spread across 5.5 cm. MRI had shown it to be 1.7cm. Surprise!

I have UCSF saying I need to be aggressive and use Adriamycin. My other oncology group disagrees. I am in the middle and need to make a decision. It's agonizing.

wishiwere

You could get a 3rd opinon. 

I have read on the boards here, women saying that ILC does not respond to chemo, but have not done the research as others have. I'd be doing a lot of research and asking questions about it all.  I have read recently that they think ILC responds better to the hormonal treatments.

Good luck and let us know what you find out

Gitane

I wrote an answer to you on the other thread.

Seabee

I'm moving to this thread because someething is wrong with the margins in the other one.

Since you are stage IIa, no node involvement, you could take the Oncotype Dx test, which gives you an idea of how likely you are to have a recurrence. If the score is higher, you could take the more aggressive approach and hope that it works.  If the score is low, you could take the hormonal route with more confidence. The test apparently does help with decision making, partly by boiling the issue down to a number.

Stage IIa is not very different from stage I in terms of percentages. You're pretty lucky. And lobular is generallly less aggressive than ductal in spite of its tendency to spread out, so that may work in your favor also.Whatever you decide, your chances of survival are quite good.

thankfulrn

Dx with ILC 3/2007. Had adrymiacin and cytoxan follwed by taxol and then radiation. Am now taking arimidex. So far so good.

unique

Jobu ~ unique here again! What if the Lobular didn't regress, it just wasn't seen well enough? Maybe it did get smaller. I am still trying to figure out how my lobular got missed when it was so big. They say it tends not to form a lump, just a sort of hazy kind of form, hard to see or feel until it's covering an area. I am still thinking remove it all surgically altho this may seem so scary to you because you are so young. But then it will be gone, and you don't have lymph node involvement, so maybe you will be done then. No more cancer! Lovely life to live from now on! Whereas if you do the Adria and it's still there, you've wasted time when it could be gone. They told me the trouble with ILC is it likes to go in a single cell form out into your body, and that can be a problem later.

You are with great docs so I am sure there are answers here for you. I am just a layperson altho obviously a fellow sufferer, so take all this with that in mind.

I think Breast Conservation is great but there are times when maybe just forget it and move on. 

Gitane

unique and jobu,  I, too, am still so blown away by how much cancer was undetected in my breast before a MRI was done.  So was my surgeon for that matter.  Treatment decisions are complicated by the long term SEs, of course, something we consider when we let ourselves believe in the idea of "long term".  For me, mastectomy was a given, so was Adriamycin.  No one I consulted waivered on either of those, so I guess my decision process was easier than the ones patients face now.  I also was told Femara was what I needed.  No wishy-washy about that, either.